Delivering cervical cancer screening has been made more complex by the introduction of the Health and Social Care Act (HSCA) 2012, concludes a study published in BMJ Open.
The research explored the impact of the HSCA on cervical cancer screening rates in areas of England identified empirically as being particularly affected by the reforms.
Semi-structured interviews were conducted with NHS commissioners, managers, clinicians, senior administrative staff from Clinical Commissioning Groups (CCGs), local authorities and service providers. This was followed by a triple-difference analysis of national administrative data.
Interviewees reported that, following the HSCA, cervical cancer screening commissioning and provision has become more complex and ‘fragmented’, with less certainty around responsibilities. The interviewees predicted this would reduce cervical screening rates in some areas more than others.
Quantitative findings supported these predictions. Furthermore, areas where CCGs dealt with multiple local authorities experienced a larger decline in cervical screening rates (1.4%) than those dealing with one local authority (1.0%).
The authors say the data demonstrate unintended consequences arising out of large-scale health system reform.
“Taken together, our findings suggest that there is an urgent need for clarification as to who holds the budget, and therefore who should be commissioning, cervical screening in the English NHS, and for local agreements to ensure that issues over funding and budgets do not disrupt screening programmes,” they say.